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Cristina Cannelli [it], leader of the DREAM programme in Guinea, granted us an interview [en] which was published in the 7 Billion Actions [en] series, commissioned by UNFPA, the UN agency for world population issues, to celebrate the population reaching 7 billion. She told us about the objectives of the programme and its achievements in September 2011. Since then, the results of various studies would seem to confirm these positive results, giving way to new approaches in the fight against the AIDS epidemic.

This time we have interviewed Paola Germano, head of the DREAM programme for all Africa.

Global Voices (GV): According to recent reports from various sources, it would seem that AIDS cases are declining. Can you confirm this based on your experience with Comunità di Sant'Egidio's DREAM programme?

Paola Gemano: Yes. In most of the countries we work in, the epidemic has stabilised, and in some countries we are even seeing a reduction in the number of new cases. According to UNAIDS predictions, in the entire Sub-Saharan Africa, in 2010 we had 16% fewer cases compared to 2001.

GV:Could you explain how we achieved such positive results?

PG: The reduction in cases is due to a combination of factors: it is in part due to the natural cycle of the epidemic, but it is also a result of the recent efforts, with precautionary measures; the increased awareness of governments and citizens; and above all the increased coverage of antiretroviral treatments. We know that, in countries with low or medium development levels, more than 6 million people benefit from the antiretroviral treatment. When the DREAM programme first started, there were very few centres where the treatment was offered. Today the treatment is available in most of Africa, even if much work is still needed to reach everyone!

GV: Is there a reduction in the number of cases in all the countries where there is the DREAM programme?

PG: We have had particularly good results in Malawi, Kenya and Tanzania. For example, in Malawi the percentage of people affected by the epidemic has gone from 15% to 11.5% in just a few years.

African mother with her child – photo from the website of the DREAM project of the Comnità di Sant'Egidio

GV: Why has there been such a positive result in Malawi?

PG: The population is small and the epidemic was not as diffused. The government, together with the organisations operating in the country, including DREAM, responded actively to the epidemic, putting thousands of people through therapy in just a few years. In 2011 an innovative approach to taking care of HIV-positive pregnant women was introduced: an infected pregnant woman quickly begins HAART (Highly Active Antiretroviral Therapy) and this approach guarantees better results in preventing the baby from becoming infected and reducing the risks for the mother.

GV: The DREAM programme had put together mobile teams that visited areas of certain African cities to offer better assistance to the AIDS suffers. How is this progressing?

PG: It's continuing, and increasing! We are intensifying the service both for people who live in rural areas like Kenya (where we have bases in the eastern regions of the country) or like Malawi (where there are few health centres and the villages are spread far apart), and to reach those who live in the suburbs of big cities like Conakry or Kinshasa. By visiting the places where our patients live we can better understand the difficulties, the problems, and together we can work out ways to overcome them.

GV: What can you tell us about Prof. Felipe Garcia's AIDS vaccine [it] that has been much talked about in the last couple of years and that, according to the media, has been shown to be effective for a certain period in reducing the development of the virus in the initial phases of the illness?

PG: Over the last few years, as well as continuing to research a vaccine, we are also researching the possibility of making a partially therapeutic vaccine, one that can improve the immune system of people who are already infected and are receiving antiretroviral therapy. However, this treatment needs to be alongside the antiretroviral therapy. In other words, they cannot replace the antiretroviral therapy. Breakthroughs have been made but for the moment they are still at the experimental phase. Research is nonetheless continuing and we hope to bring something useful to the infected people!

GV: The DREAM programme does not limit itself to only identifying and helping HIV-positive people. Could you please tell us about the other work you do in Africa?

PG: Firstly, there are, let's say, cultural activities. In other words we inform people in the countries where we haves bases about HIV, about its prevention and treatment and about the rights of HIV-positive people. An important aspect is the fight against the stigmatization of infected people. In some countries associations of people who fight against the stigma and for the right to treatment have developed around DREAM.

Often the DREAM centres are in suburban areas that lack basic services. We try as much as possible to meet the most urgent needs of the population. For example, in some of our centers, we have installed water pumps because we noticed that the people of the area did not have sufficient access to drinking water.

On the other hand, in Mozambique (Maputo and Beira) and in Malawi we have opened feeding centres for children to fight against childhood malnutrition, which is very common and has serous consequences on the life and general development of the child. Every day in these centres approximately 500 children receive a full, balanced meal.

GV: We heard that the programme also distributes food to the families of the people affected by AIDS.

PG: Yes. In many African countries people suffer because of an unstable food supply, and malnutrition aggravates the effects of HIV. Also, when people are in the advances stages of the illness, they no longer have the energy to work and so they have less money to buy food; for this reason we have identified certain categories of people who have greater need, and we try to give them a food pack for a certain period of time. Amongst the people who benefit from this are pregnant women and women who are breastfeeding: in fact giving them food reduces the risks of malnutrition for the baby; Then there are the AIDS sufferers who arrive at the centre already showing signs of malnutrition to whom we offer basic food pack for the first 6 months of treatment. It is usually long enough for their health to return and then they get their strength back and can work. We offer nutritional aid in all the countries where we work, however, it must be said that with the economic crisis it is becoming ever more difficult to find partners who will help and sustain us in this area.

PG: BRAVO! is a programme run bu Sant'Egidio which is integrated with DREAM, but it is another programme.

GV: Is there anything you would like to add for our readers?

PG: For us DREAM is not only about offering medical aid but it is also an important human and spiritual experience: we have seen how uniting many people's efforts we can face problems that seem insurmountable, changing the destiny of many people. This encourages us to not give up when faced with the impossible, and to overcome it!

Sant'Egidio's website says that BRAVO!'s aim is to guarantee children's registration at the moment of birth, though improved registry services, making parents and children aware of this and by collaborating with the ministries and government institutions in charge. Talks are underway for another interview with the leaders of BRAVO! to illustrate the results they have achieved, the difficulties they encountered and what the future has in store.

The publication of this interview was made possible thanks to Marisa Petricca, who reviewed it and helps gather appropriate references, photos and videos.